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By Sam Piha
The purpose of this blog is to advance understanding of Attention- Deficit Hyperactivity Disorder (ADHD). In the subsequent blog we will share some strategies on supporting kids with ADHD features.
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder marked by persistent patterns of inattention, hyperactivity, and impulsivity. It affects both children and adults, typically leading to executive dysfunction. Symptoms vary in intensity and can disrupt daily life at home, work, school or afterschool. [i]
“About 1 in 9 U.S. children has received a diagnosis of attention deficit hyperactivity disorder (ADHD). According to the Centers for Disease Control and Prevention (CDC), ADHD is one of the most common neurobehavioral disorders in children. Parents, teachers, and healthcare professionals may suspect ADHD when they notice careless mistakes, fidgeting, or forgetfulness. However, many medical conditions can mirror ADHD symptoms, which can make getting a correct diagnosis difficult.” [ii]
The main features of ADHD are inattention, hyperactivity, and impulsivity. Some people have trouble in all three of those areas. Some primarily have problems with inattention. And others may primarily have problems with impulsivity and hyperactivity. ADHD symptoms exist on a spectrum or a continuum. But the longer answer is a little bit more complicated. There are two important factors to consider: the type of symptoms a person has and how intense the symptoms are.
ADHD manifests differently from person to person and is categorized into three types:
- Predominantly Inattentive: Difficulty sustaining focus, poor organization, forgetfulness, and a tendency to lose items.
- Predominantly Hyperactive-Impulsive: Fidgeting, excessive talking, restlessness, and acting without thinking through consequences.
- Combined: A mix of symptoms from both categories, which is the most common presentation. [iii]
Students who exhibit ADHD’s hallmark features of inattention, hyperactivity, and impulsivity can be frustrating. Plus, their behaviors take time away from instruction and disrupt the whole class. These youth may:
- Demand attention by talking out of turn or moving around the room.
- Have trouble following instructions, especially when they’re presented in a list, and with operations that require ordered steps, such as long division or solving equations.
- Often forget to write down homework assignments, do them, or bring completed work to school.
- Often lack fine motor control, which makes note-taking difficult and handwriting a trial to read.
- Have problems with long-term projects where there is no direct supervision.
- Not pull their weight during group work and may even keep a group from accomplishing its task.
Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with attention deficit hyperactivity disorder (ADHD or ADD) have a hard time doing—not because they aren’t willing, but because their brains won’t let them. That doesn’t make teaching them any easier, of course.
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Children and teens with ADHD often pay the price for their problems in low grades, scolding and punishment, teasing from their peers, and low self-esteem. Meanwhile, you, the teacher, feel guilty because you can’t reach the child with ADHD features and wind up taking complaints from parents who feel their kids are being neglected in the classroom. But it doesn’t have to be this way. There are strategies you can employ to help students with ADHD features overcome learning challenges, stay focused without disrupting others, and succeed in the classroom.
Causes and Risk Factors: ADHD is not caused by poor parenting. Research points to a combination of genetics and neurological differences, particularly in brain areas regulating attention and impulse control. Key risk factors include:
- Genetics: ADHD often runs in families.
- Environmental factors: Exposure to toxins like lead during childhood.
- Developmental factors: Premature birth, low birth weight, or maternal use of tobacco, alcohol, or other drugs during pregnancy.
Most afterschool workers are not trained to be diagnosticians. Instead, we should focus on behavioral features and how we can best support young people with ADHD features.
Diagnosing ADHD is very tricky. “People often think of ADHD as being just one thing. To some it might mean the stereotype of the hyperactive boy who can’t sit still in school. To others, it might mean the friend who never seems to pay attention. But ‘no two people with ADHD are exactly alike.’ Their symptoms can vary in type and severity. For instance, one person with hyperactivity might squirm in their seat. Another might get up and walk around the room, touching everything in sight. So, you might think of the first person as having ‘mild’ ADHD and the other as having ‘severe’ ADHD. This is why diagnosing ADHD can be tricky. ADHD isn’t an all-or-nothing thing. And sometimes, what looks like ADHD might not be a sign of an issue at all. All people have times when they’re forgetful, struggle to wait their turn, or are easily distracted. That doesn’t mean they have ADHD, though.
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| Source: Families First Pediatrics |
It should be noted that significant racial and gender disparities persist in ADHD diagnosis, with Black, Hispanic, and Asian individuals, as well as girls and women, facing underdiagnosis, misdiagnosis, and delayed care compared to White males.
- Racial Disparities
- Underdiagnosis in Minority Groups: Asian, Black, and Hispanic children are significantly less likely to receive an ADHD diagnosis than White children, regardless of symptom severity. ‘Asian, Black, and Hispanic children were significantly less likely to be diagnosed with ADHD compared with White children,’ as noted by PMC - NIH.
- Misdiagnosis as Conduct Issues: Black youth are frequently misdiagnosed with behavioral or conduct disorders instead of ADHD, often due to harsher punitive interpretations of behavior in school and systemic bias. ‘non-Hispanic White individuals were ~ 26% more likely to receive ADHD diagnosis and ~ 61% less likely to be diagnosed with CD than non-Hispanic Black individuals,’ according to Nature.
- Intersection of Race and Gender: Studies show that Black females are among the least likely demographic groups to receive a timely ADHD diagnosis.
- Gender Disparities
- The Diagnostic Gap: Boys are diagnosed with ADHD at much higher rates in childhood than girls, though adult prevalence rates are nearly equal. “Girls and women experience an average delay of about 4 years in their diagnosis of and treatment for attention-deficit/hyperactivity disorder (ADHD), relative to boys and men,” according to Psychiatry Advisor.
- Inattentive Presentation: Girls typically display less disruptive, inattentive symptoms rather than overt hyperactivity, causing adults to overlook their struggles.
- Masking and Coping: Women and girls frequently internalize or mask their symptoms, leading to high rates of comorbid anxiety and depression that obscure the underlying ADHD. [iv]
There are some conditions that may resemble ADHD, which are cited below:
- Bipolar disorder
- Autism spectrum disorder
- Low blood sugar levels
- Diabetes
- Sensory processing disorder
- Hearing problems
- Sleep Thyroid disorders
- Seizure disorders
- Kids being kids: Some children with an ADHD diagnosis are actually misdiagnosed and don’t have ADHD or any other health condition. They’re simply being themselves, such as easily excitable or bored. [v]
[i] National Institute for Mental Health, Attention-Deficit/Hyperactivity Disorder: What You Need to Know
[ii] Healthline, Conditions That Mimic ADHD
[iii] The Understood Team, The 3 Types of ADHD
[iv] Google AI, What kinds of racial and gender disparities exist when diagnosing ADHD?
[v] Healthline, Conditions That Mimic ADHD
